Automatic prescription drug dispenser

ABSTRACT

An automatic prescription drug dispenser including a remote dispenser, a prescription entry system, and a communications network. The remote dispenser transmits and receives information from the communications network and dispenses prescription drugs to the patient. The prescription entry system transmits and receives information from the communications network and provides an input system for the prescriber to electronically enter individual prescriptions for each patient. The communications network coordinates communications between the doctor, insurance carrier, and the remote dispenser. The remote dispenser stores, retrieves, and labels prescription drug and over-the-counter products directly to patients through a remote automated dispenser, a prescription entry system, and a communications network. The remote dispenser transmits and receives information from the communications network and dispenses drugs to the patient. The prescription entry system transmits and receives information from the communications network and provides an input system for the doctor to electronically enter individual prescriptions for each patient. The communications network coordinates communications between the prescriber, insurance carrier, and the remote dispenser. Also described are various embodiments of apparatus and method of the invention useful in pharmacy settings as for example found in drug stores or “big box” retailers or other such settings. Other methods include providing a remote dispenser in virtually any location.

PRIORITY OF INVENTION

[0001] This application claims priority of invention under 35 U.S.C.§120 from U.S. application Ser. No. 09/714,802, filed Nov. 16, 2000,which is a non-provisional application filed under 35 U.S.C. §119(e) ofU.S. Provisional Application No. 60/210,303 filed Jun. 8, 2000, both ofwhich are incorporated herein by reference.

TECHNICAL FIELD

[0002] The present invention concerns dispensing systems, such asvending machines, particularly dispensing systems for prescriptiondrugs.

BACKGROUND

[0003] U.S. application Ser. No. 09/714,802 describes a prescriptionmedication dispensing machine capable of, among other things,automatically labelling a medication for dispensing to a specificpatient in response to electronic prescription data supplied to themachine. This application presents various applications and improvementsto the embodiments illustrated in U.S. Ser. No. 09/714,802. Inparticular, but not limited thereto, the present application describesapplications and alternate embodiments of the apparatus particularlyuseful in pharmacy settings in drug stores or other establishments like“big box” retailers.

SUMMARY

[0004] The present discussion includes a number of different method andapparatus embodiments useful in, among other things, the dispensing ofprescription medications at a pharmacy that may or may not be staffedwith live pharmacy personnel during some or all of its operating hours.

BRIEF DESCRIPTION OF DRAWINGS

[0005]FIG. 1 is a schematic diagram of a high-level computer systemarchitecture according to one embodiment.

[0006]FIG. 2 is a schematic diagram of a software architectureembodiment of the remote dispenser according to one embodiment of thepresent invention.

[0007]FIG. 3 is a schematic diagram of a process by which a patient isseen by a prescriber, receives a prescription, and has the prescriptionfilled by the remote dispenser according to one embodiment of thepresent invention.

[0008]FIG. 4 is a schematic diagram of a patient registration processaccording to one embodiment of the present invention.

[0009]FIG. 5 is a schematic diagram of a prescription writing processaccording to one embodiment of the present invention.

[0010]FIG. 6 is a schematic diagram of a patient discharge processaccording to one embodiment of the present invention.

[0011]FIG. 7 is a schematic diagram of a process of modifying anestablished prescription according to one embodiment of the presentinvention.

[0012]FIG. 8 is a schematic diagram of a process of ordering stock foreach remote dispenser according to one embodiment of the presentinvention.

[0013]FIG. 9 is a detailed schematic diagram of the process of orderingstock for each remote dispenser according to one embodiment of thepresent invention.

[0014]FIG. 10 is a schematic diagram of a process by which a patient hasa prescription filled by the remote dispenser according to oneembodiment of the present invention.

[0015]FIG. 11 is a front view of a remote dispenser according to oneembodiment of the present invention.

[0016]FIG. 12 is a side cross sectional view of a remote dispenseraccording to one embodiment of the present invention.

[0017]FIG. 12B is a front view of a remote dispenser according to oneembodiment of the present invention.

[0018]FIG. 13 is a front cross sectional view of a remote dispenseraccording to one embodiment of the present invention.

[0019]FIG. 14 is an exploded perspective view a magazine and lead screwsystem according to one embodiment of the present invention.

[0020]FIG. 15 is a front view of a gantry transport system according toone embodiment of the present invention.

[0021]FIG. 16 is a front view of a y-axis system of the gantry transportsystem according to one embodiment of the present invention.

[0022]FIG. 17 is a cross sectional view of a y-axis system according toone embodiment of the present invention.

[0023]FIG. 18 is a perspective view of an end effector according to oneembodiment of the present invention.

[0024]FIG. 19 is a side view of a product rotator according to oneembodiment of the present invention.

[0025]FIG. 20 is an end view of the product rotator according to oneembodiment of the present invention.

[0026]FIG. 21 is a perspective view of a label printer assemblyaccording to one embodiment of the present invention.

[0027]FIG. 22 is a perspective view of a moveable printer according toone embodiment of the present invention.

[0028]FIG. 22B shows a perspective view of portions of a dispenseraccording to one embodiment.

[0029]FIG. 22C shows a perspective view of a product delivery chuteaccording to one embodiment.

[0030] FIGS. 23-30 are screen views of one embodiment of a prescriptionentry system for a handheld computing device.

[0031] FIGS. 31-47 illustrate additional embodiments of systems, methodsand configurations for use of medication dispensing machines accordingto the present invention.

[0032]FIG. 48 illustrates an alternate embodiment of a dispensingmachine according to the present invention.

[0033]FIG. 49 illustrates a dispensing system according to oneembodiment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0034] The following detailed description, which references andincorporates the Figures, describes and illustrates one or more specificembodiments of the invention. These embodiments, offered not to limitbut only to exemplify and teach the invention, are shown and describedin sufficient detail to enable those skilled in the art to practice theinvention. Thus, where appropriate to avoid obscuring the invention, thedescription may omit certain information known to those of skill in theart.

[0035] The automatic prescription dispensing system provides safe,convenient and immediate prescription drug service to patients inprimary, urgent, acute, and emergency care settings. Further examplesprovide prescription drug service to patients in pharmacies, either withor without the intervention of a pharmacist. The system can be used invirtually any location, such as doctor's office, a kiosk in a mall, or abus station, for example. The system can deliver prescribed medication,over-the-counter (OTC) medication, and medical supplies, such assyringes. Some embodiments can deliver virtually any dispensable orvendible product.

[0036] The system provides several advantages including, but not limitedto, entry of a prescription into a handheld computer using a uniquesoftware application, downloading of prescription and patient data froma central server database, acceptance of credit, debit, smart and ATMcards, cash, or check. The system includes automatic verification bybarcode of each drug package for correct drug and expiration date beforedispensing, optional prescription print-out instead of dispensing theprescription drugs, dispensing of appropriate drug education informationand payment receipts, transfer of information to and from a centralserver database regarding available product information, restocking,product returns, prescription-filled and prescription-printed flags,patient requests for automatic refills and refill reminders, failureinformation, the ability to alert the central server if security of thedispensing system is compromised, and other miscellaneous two-wayinformation transfers between a patient and a central control via atouch screen or other interface.

[0037] System Architecture

[0038]FIG. 1 is a schematic diagram of a high-level computer systemarchitecture embodiment of the invention. The system 1000 is adistributed network comprising a central server 2000, a remote dispenser3000, and one or more prescription and patient data entry systems suchas HCF system 4000. A patient who visits a physician or other providerat a healthcare facility (HCF), such as a clinic, where an HCF system4000 (or other prescription entry system) is located receives aprescription that is filled at the remote dispenser 3000 if theprescription is so authorized, or adjudicated (if there is no insurance,the prescription need not be adjudicated), by central server 2000. Todecide whether to authorize the prescription, central server 2000 is indistributed network communications with the adjudication system 5000, apayment authorization system 6000, such as a credit card authorizationsystem, a check verification system 6000A, or other payment scheme, amail order system 6999, a prescription bottler system 7000, and a drugformulary update service 8000. Here, adjudication system 5000 routes anyinsurance claims to third-party payors 9000 (TPP). If a claim is deniedby the TPP, the rejected claim is routed to a call center 9050. The callcenter 9050 analyzes the rejection and views scanned insurance cardimages. After any corrections are made, the claim is resubmitted or theprescription is printed for the patient. The call center 9050 can alsobe in communication with the clinic and with a user via a phone or othercommunications means at remote dispenser 3000.

[0039] Central Server

[0040] Central server 2000 captures all data that is created by thevarious other components of the system 1000. It also prepares, sends,and receives all adjudicated claims; prepares, sends, and receives allcredit card, cash, or check payments; and retains inventory data for allremote dispensers.

[0041] An example of the hardware and software that are suitable for thecentral server 2000 is a Compaq Prolient 1800 computer system 2100 thatis expandable to dual processors, one gigabyte of SDRAM central memory,and 250 gigabytes of SCSI hard drive storage 2200; Microsoft Windows NTServer 4.0 operating system; and Microsoft SQL Server 7.0 database.Other generally equivalently performing hardware and software could besubstituted in a known manner without limiting the scope of theinvention. In accordance with known principles, the design of the systemshould be such that the system functions are not dependent upon theparticular hardware or software selected for implementation, thuspermitting the system to migrate to other hardware or software platformswithout any change in the scope of the invention.

[0042] A software application running on the central server 2000 isresponsible for setting up authorized HCF systems 4000 and prescribersof prescriptions. This application is preferably written in Java fordisplay in an Internet browser application running on a client of thecentral server 2000 or a HCF system 4000 (assuming appropriateauthorization criteria are met).

[0043] Another software application running on the central server 2000is responsible for generating reports to document the operation andperformance of system 1000 in accordance with well-known principles.Reports are preferably created on central server 2000 and sent to aprinter anyplace on the network for generation of hard copy. Acommercially available report generation system, preferably but notnecessarily Crystal Reports, may be used to format the report data inaccordance with well-known principles.

[0044] Another software application running on the central server 2000is responsible for processing transactions associated with theadjudication of valid prescriptions (if necessary). A commerciallyavailable adjudication application, preferably but not necessarilyclaims Engine 2000, may be used in accordance with well-known principlesto exchange data between central server 2000 and adjudication system5000.

[0045] Another software application running on the central server 2000is responsible for packaging, sending and receiving credit card, cash,check, or other type payment and reversal transactions generated bypatients who must pay for the prescriptions they receive. A commerciallyavailable but proprietary authorization application, provided by thecredit card vendor(s), may be used in accordance with well-knownprinciples to exchange data between central server 2000 and credit cardauthorization server 6000. In the same manner, check authorization canbe performed using a system such as Telecheck, using a service such aselectronic check acceptance (ECA).

[0046] Another software application running on the central server 2000is responsible for monitoring the inventory levels of the variousproducts dispensed from each of the remote dispensers 3000. Inaccordance with known principles, monitored inventory levels are used todetermine reorder points (times and quantities) for the products. Thisapplication also determines which National Drug Code (NDC) is used toadjudicate the prescription when a particular product is prescribed. Theapplication is preferably written in Java for display in an Internetbrowser application. The application will run both on the central server2000 and on the HCF workstation 4200. Optionally, inventory levels aremonitored by the remote dispenser 3000. The central server 2000 providesvendor and product information and the remote dispenser 3000 wouldinteract with the vendors and perform the inventory control functions.Summary reports are uploaded to the central server 3000.

[0047] Another software application running on the central server 2000is responsible for importing and maintaining the drug information. Thepreferred method is to import and maintain drug data files 8000 providedby First Databank (FDB), using an application written in Java and usingthe FDB toolkit provided by the vendor.

[0048] Another software application running on the central server 2000is responsible for setting the price of products dispensed from remotedispenser 3000. The preferred embodiment is a program written in Java.

[0049] Remote Dispenser

[0050]FIG. 2 is a schematic diagram of the software architecture of theremote dispenser 3000. From a software standpoint, remote dispenser 3000comprises two major subcomponents, dispenser module 3100 and managermodule 3200, which communicate with each other in any well-known manner.Dispenser module 3100 controls the actual dispensing of the product fromthe remote dispenser 3000. Given properly verified data, dispensermodule 3100 will dispense properly labeled product. To do so, it issuesappropriate commands to motor 3125, scanner 3150 and label printerdriver 3925 based on communications with manager module 3200 and localcache 3300.

[0051] Manager module 3200 is the main controller of remote dispenser3000. It coordinates and controls the interaction between all of theother hardware and software components of the remote dispenser 3000. Itcommunicates with dispenser module 3100, local cache 3300, userinterface 3400, server interface 3500, power monitor 3600, temperaturemonitor 3700, cash handler or debit, ATM, smart, or credit card readerdriver 3800, or a check reader 3825, or a cash acceptor 3830 and changereturn 3835, and prescription/receipt printer driver 3900.

[0052] Local cache 3300 is responsible for storing and retrieving datain local storage 3350. The local cache 3300 manages data related toproduct inventory, system configuration, and advertising. Itcommunicates with dispenser module 3100 and manager module 3200 asrequired. Local storage 3350 is any appropriate data storage deviceperforming typical data storage and handling in a well-known manner.

[0053] User interface 3400 is responsible for interacting with patientsand maintenance personnel. It controls the screen display shown onvisual monitor 3450, and also manages timeouts that can be encounteredat each step of the process of using remote dispenser 3000.

[0054] Server interface 3500 is responsible for communications with thecentral server 2000. It will send and receive data between the remotedispenser 3000 and the central server 2000. It is also responsible fortranslating data to and from formats required by the remote dispenser3000 and central server 2000.

[0055] Power monitor 3600 monitors the normal line voltage power supplyto remote dispenser 3000 and activates uninterruptible power supply(UPS) 3650 as required.

[0056] Temperature monitor 3700 monitors the ambient temperature insideremote dispenser 3000 with a temperature sensor 3750.

[0057] Card reader driver 3800 allows manager module 3200 to operate acommercially available cash handler, ATM, smart debit or credit cardreader 3850 in a well-known manner.

[0058] Check reader 3825 can be a check reader such as a check readerdistributed by Magtek Inc. As discussed above, the check reader can beoperatively coupled to central server 2000 to allow for checkauthorization to be performed using a system 6000A, such as Telecheck,using a service such as electronic check acceptance (ECA).

[0059] Prescription/receipt printer driver 3900 allows manager module3200 to operate a prescription/receipt printer 3950 in a well-knownmanner.

[0060] Label printer driver 3925 allows dispenser module 3100 to operatea label printer 3975 in a well-known manner.

[0061] Some options include a security alarm sensors 3760, a camera 3765to take a patient's picture or picture of an I.D., and an electroniclock system 3770. Camera 3765 can also be located within the remotedispenser to provide and internal view of the various mechanisms of thedispenser. Thus it can be used as a diagnostic tool to help maintain thedispenser.

[0062] One option includes a telephone 3980 on the dispenser to allowthe user to speak with the central control and call center to discussany insurance problems, for example. The telephone can also allow aremote pharmacist or other health care provider to ask or answer anyquestions by the user.

[0063] Manager

[0064] The manager module 3200 comprises various other software modulesto support the following activities at the remote dispenser 3000.

[0065] Dispensing of Products

[0066] In one example, a patient who has a valid prescription voucherfrom a physician initiates the dispensing activity at visual monitor3450. The patient inputs the voucher number, patient birth date (orother validation method), their selection of products (if any beyondthose included in the prescription), and, if necessary, a check intocheck reader 3825, cash into cash acceptor 3830, or a credit, debit,ATM, or smart card number through use of card reader 3850. One optionincorporates a “Bluetooth” or infrared enabled system within thedispenser which is in communication with a payment server, thus allowinga user to pay using a cell phone, or other Bluetooth (or infrared)enabled device. Manager module 3200 communicates with central server2000 to authorize the entire transaction. Once authorized, managermodule 3200 communicates with dispenser module 3100 to generate thedispensed medications; and with prescription/receipt printer driver 3900to print appropriate information and receipts on prescription/receiptprinter 3950. The system can also print up advertising, coupons, patientinformation, or other marketing information. The patient receives drugspecific education advertising via a screen or printer while product isbeing received. The information can be tailored to be drug specificand/or patient specific. The patient can be asked if they would likeadditional information about their medication sent to them, such asreminders about refilling their prescriptions, or if they would like tobe in a drug compliance program, for example. In addition, a toll freepharmacist helpline is offered via the interface or over telephone 3980.The interface can also provide marketing or educational information orquestionnaires.

[0067] In other examples, which will be further discussed below, thepatient (or patient's agent, such as a friend or family member) caninsert a regular written prescription into the dispenser. The dispensercan image the prescription and transfer the image to a pharmacy servicesprovider who can control the dispenser to deliver the medication orsupplies.

[0068] Restocking of Products

[0069] An HCF staff person, for example, initiates the restockingactivity. This person would typically be a local person at the HCF atwhich remote dispenser 3000 is located who has the proper securityauthorization. Restocking involves removing magazines that are empty orthat have been selected for removal (e.g., expired or supercededproducts). Manager module 3200 tracks restocking activity andcommunicates appropriate data over server interface 3500 to centralserver 2000 so that proper inventory control is maintained. After eachrestocking, or after each time the door is opened, the system goesthrough each position within the dispenser to verify and update thelocation of each item in the dispenser. This means that the restockingperson does not have to worry that they are putting the right product inthe correct slots. Wherever they put it, the system will rescan eachslot and update the position each product. Moreover, since themedication comes pre-filled and prey checked in the magazines (fromprescription bottler 7000, for example), the system provides afool-proof, safe medication delivery paradigm.

[0070] Diagnostics

[0071] A maintenance person initiates the diagnostic activity. Thisperson would typically be a dedicated maintenance person who travelsfrom one remote dispenser 3000 to the next. Diagnostics include testingthe availability and functionality of the hardware components of remotedispenser 3000. In addition to testing individual components, the entiredispensing activity can be tested by dispensing a placebo or otherproduct.

[0072] The maintenance and diagnostic routines are preferablyimplemented by putting an invisible button on the voucher number entryscreen portion of visual monitor 3450. For example, after entering aspecial password code for voucher number, and pressing the hidden buttontwice, the maintenance mode is entered if the special password code isotherwise valid. A selection of available options, depending onauthorization level, is displayed: restocking of products, rescanning ofproduct magazines to verify inventory; display of current inventory(including an option to print the result on prescription/receipt printer3950); diagnostic routines; communication status (e.g., “pinging” otherdevices to ensure that communications links are active); dispensing aplacebo product to display the status of the dispensing operation byexercising all devices including motors, scanners, and printers (theplacebo product will be labeled to test label printer 3975); manualoperation of available hardware (e.g., activating various motors,displaying scanned input from a test of input devices, and the like);confirmation of configuration for devices that are configurable (e.g.,communications port parameters, logical addresses of each device); and,status of communications to central server 2000 (typically a multi-steproutine in which first visual monitor 3450 displays the status of theconnection to central server 2000, followed by an active pinging ofcentral server 2000, followed by pinging of any router that may bebetween server interface 3500 and central server 2000, etc.).

[0073] Advertising and/or Educational Information

[0074] Visual monitor 3450 may display information such as educationalinformation or advertisements during idle times and during certainstages of the dispensing activity. The educational information oradvertisements may be in the form of images, animation, audiovisualworks, etc. without limiting the scope of the invention.

[0075] Error Recovery

[0076] Manager module 3200 will attempt to recover from errors that areencountered during dispensing. Such errors include communicationproblems with the central server 2000, and hardware problems on theremote dispenser 3000. The central server 2000 will be appropriatelynotified of the errors.

[0077] Monitoring

[0078] Manager module 3200 notifies central server 2000 when appropriateboundary conditions are approached or exceeded. Such conditions includetemperature, interruption to normal line voltage power supply, papersupply for each printer 3950 and 3975, physical access to remotedispenser 3000, and failed dispensing caused by mechanical or electricalfailure, for example.

[0079] HCF System

[0080] Referring again to FIG. 1, each HCF system 4000 comprises apatient registration client 4100, a HCF workstation 4200, one or morecomputers 4300 (as an example only, FIG. 1 shows four such handheldcomputers 4300, computers 4300 can also be desktop or laptop computers),and one or more laser or thermal printers 4400. Registration client 4100may be any suitably configured network capable personal computer ordedicated terminal in communication with HCF workstation 4200. HCFworkstation 4200 may be any suitably configured network capable personalcomputer; the preferred configuration is a small form factor personalcomputer from Compaq, running Microsoft Windows NT Workstation 4.0.Computer(s) 4300 may be any suitably configured desktop or portablecomputer such as a laptop, palmtop, personal digital assistant, etc. Thepreferred model is a Palm Vx from Palm Computing, running Palm OS.Another example model is a PC having a web-based application. Printer4400 is connected to the HCF system 4000 in a well-known manner and maybe any suitably configured model of laser or thermal printer.

[0081] A software application for client registration runs on the HCFworkstation 4200, and is written in a language pertinent to thatplatform, preferably Java for display in an Internet browser applicationrunning on the patient registration client 4100. One option includes aninsurance card scanner 4120 to allow the HCF personnel to input an imageof the insurance card into the system.

[0082] A software application for prescription writing runs on both thehandheld computers 4300 and the HCF workstation 4200, and is written inlanguages pertinent to each platform. The software application processesthe creation of prescriptions and vouchers that may be used to obtainprescriptions from the remote dispenser 3000; printing of prescriptions,vouchers, and adjudication results; and modifications to prescriptionsand vouchers. The portion of the software that runs on the handheldcomputers 4300 is preferably an application for the Palm OS developedwith the CodeWarrior development platform, but this is not a limitationon the scope of the invention. The portion of the software that runs onthe HCF workstation 4200 is preferably a Java application for display inan Internet browser application running on the workstation 4200, butthis also is not a limitation on the scope of the invention.

[0083] Each HCF system 4000 is connected to the central server 2000through well-known networking techniques, such as a frame relay cloud ora virtual private network (VPN) or both. Other networking techniquesinclude dial-up, ISDN, satellite uplink, etc.

[0084] Adjudication System

[0085] The adjudication system 5000 can communicate with third partypayers 9000 through a “switch” company such as Envoy or NDC. Acommercially available application, provided by the third party payor,may be used in accordance with well-known principles to exchange databetween central server 2000 and adjudication system 5000.

[0086] Cash, Check, Credit, Debit, ATM, or Smart Card AuthorizationSystem

[0087] The card authorization system 6000 is under the control of athird-party credit card transaction clearing house. As noted above,custom written software is used to exchange data between central server2000 and credit card authorization system 6000. Check authorization canbe accomplished as discussed above.

[0088] Mail Order and Prescription Bottler Systems

[0089] The mail order system 6999 and the prescription bottler system7000 can be under the control of a third-party distributor of productsto be provided to remote dispenser 3000. A commercially availableapplication, provided by the distributor, may be used in accordance withwell-known principles to exchange data between central server 2000 andsystems 6999 and/or 7000. Systems 6999 and 7000 can be FDA-approvedrepackaging systems to repackage unit doses from manufacturers intoprescription size packages.

[0090] Drug Formulary System

[0091] As described above, the preferred method for importing andmaintaining drug formulary files on the central server 2000 is to importand maintain drug formulary data files 8000 provided in any convenientformat. Such files can be transferred and managed using any well-knowndata storage medium, or they may be transferred and managed using adirect network connection between central server 2000 and the publisherof the drug formulary data files.

[0092] Patient Visit and Prescription Process—Overview

[0093]FIG. 3 illustrates the basic process by which a patient is seen bya prescriber, receives a prescription, and has that prescription filledby remote dispenser 3000. In the patient registration process, thepatient presents himself or herself at a registration desk where patientregistration client 4100 is located. Patient information is captured bypatient registration client 4100 and transferred to HCF workstation4200, or if the system omits workstation 4200, the information can betransferred directly to central server 2000 (See FIG. 1). If the patienthas insurance, the insurance card can be scanned with scanner 4120. Inthe examination process, a prescriber (typically a physician) examinesthe patient and, depending on the outcome of the examination, may desireto prescribe a product for the patient. In the prescription writingprocess, the prescriber uses the computer 4300 to write a prescriptionby entering the prescription data into the handheld computer 4300 andtransferring the data to the HCF workstation 4200. In one embodiment,the prescriber can bypass the handheld computer and directly enter theinformation into workstation 4200. Some embodiments of the presentsystem omit computer 4300 and allow the prescriber to simply write outthe prescription on a typical prescription pad, as will be discussedbelow. In another example, the prescriber can call the prescription into the call center 9050. In another example the prescriber may havetheir own prescription entry system and they can enter it into thatsystem and then upload the data to the central server.

[0094] In the adjudication process (if the patient has insurance), datarepresenting the prescription and associated insurance information ofthe patient is sent by the HCF workstation 4200 to the central server2000 for processing and subsequent transmission to the adjudicationsystem 5000 under the control of a “switch” company that routes theprescription information to the proper third party payer. Theadjudication system 5000 transmits data regarding the outcome of theadjudication to the central server 2000, which processes it accordinglyand notifies the HCF system 4000 of the outcome. If necessary, the HCFstaff can resolve any outstanding issues and retrieves the adjudicatedprescription and/or voucher from printer 4400 of HCF system 4000. In oneembodiment, rejections can be routed to call center 9050. The callcenter 9050 analyzes the rejection and views scanned insurance cardimages. After any corrections are made, the claim is resubmitted or theprescription is printed for the patient.

[0095] In the discharge process, the HCF staff transfers theprescription or voucher to the patient as part of terminating theexamination process. In the prescription retrieval step, the patientuses a check, cash, a voucher or their card at the remote dispenser 3000to have their prescription filled. This process involves the remotedispenser 3000 communicating with the central server 2000 forverification, inventory control, and other purposes. The remotedispenser 3000 can also be connected to call center 9050 to allow forany questions or problems to be resolved.

[0096] Patient Registration Process

[0097]FIG. 4 illustrates the patient registration process in moredetail. The patient provides basic information to the registration clerkor the information is retrieved from a patient database. Such data wouldtypically include mandatory information (name, gender, date of birth,mailing address, and telephone number) and optional information (socialsecurity number; weight; known allergies; prescriber name; prescriptionbenefit insurance company name, policy number, group number, membernumber, and relationship code). Either the patient registration client4100 contains an automatic interface to an existing registration system,or an application that captures the necessary information for the firsttime, or the information is manually entered into the system or theinformation is faxed or scanned to a remote location for manual entry,or some combination of the above. In either case, the captured data isimmediately transferred to HCF workstation 4200, central server 2000,and subsequently to the specific computer 4300 (handheld or desktop) inuse by the specific prescriber assigned to the patient. Also, at thistime, the patient's insurance card can be scanned into the system.

[0098] Prescription Writing Process

[0099]FIGS. 5A and 5B illustrate the prescription writing process inmore detail. The prelude to the specific process of writing a specificprescription is for a prescriber to obtain a handheld computer 4300 (orother computer or any suitable electronic data entry device) suitablyconfigured for the patient that is about to be examined by theprescriber. The prescriber confirms whether the computer 4300 isproperly configured with information pertinent to the HCF in which it islocated, a process that could occur once each day when the prescriberfirst arrives at the HCF. If not, a well-known synchronization (or, morecommonly, a “sync”) of the computer 4300 to the HCF workstation 4200 ordirectly to the central database server will configure the computer4300. A similar process is required for confirmation whether thecomputer 4300 is configured with information pertinent to the currentprescriber, a process that could occur if prescriber uses a computer4300 that is resident at that particular HCF and shared between multipleprescribers. Once the HCF and prescriber are both properly configured inthe computer 4300, the prescriber performs a password-based loginprocess. The sync may occur via infrared frequency or may occurautomatically via a number of wireless technologies.

[0100] The prescriber examines the patient and decides whether toprescribe a product. If so, the prescription writing module isactivated. First it must be confirmed whether the computer 4300 isconfigured with information pertinent to the current patient. If not, async process is performed to retrieve the pertinent data from the HCFworkstation 4200 or central database server. The prescriber can thenchoose from a “my patient” list of patients or an “all patients” list ofpatients. Once the computer 4300 is ready to receive a prescription forthe current patient, the patient's weight is entered (if in pediatricdosage mode). The user can then choose between a list of “mymedications” and “all medications.” The drug lists show or flag for theprescriber which of the drugs are presently in the automatic drugdispenser. A drug is chosen, and strength and dosage of the drug arechosen. One example determines if the patient has any allergies to themedication.

[0101] Since the patient's insurance plan can be uploaded to thecomputer along with other patient information, each drug viewed willusually indicate whether the drug is on the patient's insurer'sformulary along with its approval status and whether the drug is in theremote dispenser. If the drug is not on the patient's insurer'sformulary, the prescriber may be prompted to a drug of the sametherapeutic class that is covered on the patient's insurer's formulary.

[0102] A default entire prescription for the chosen drug will thenappear on the computer 4300. The prescriber can accept the defaults orchoose others from a list, or write in their own. The prescriber mayselect a well-known SIG code for the product if one is available,otherwise one may be written by the prescriber. Similarly, if a standardquantity is available, it may be chosen, otherwise the prescriber maychoose a quantity. The number of refills permitted without the patientrequiring a new prescription is chosen, and the prescriber indicateswhether the prescription is to be “dispensed as written,” i.e., anequivalent generic drug can not be substituted in place of the specificbrand of drug for which the prescriber has written. The prescription mayundergo a drug utilization review (DUR). This includes drug-druginteraction, dosage range checking, patient allergy checking, pregnancyand lactation alerts and other safety checks. This entire process isrepeated for the each product prescribed.

[0103] As noted above, the prescription writing system includes a“pediatric” dosage calculation mode when writing a prescription for achild, for example, or at any time dosage is critical. In that case, theuser has the option, before selecting the drug name, to toggle thesystem into pediatric dosage mode. The prescriber will then be promptedto enter the patient's weight. After that, the daily dose is selected.As the prescriber adjusts the daily dosage, the system automaticallycalculates the exact dosage (in units per day). The prescriber thenchooses the form and strength of the drug (if the prescriber selects adose that exceeds the maximum recommended dose/m/k/day, they will beprompted to answer a question confirming their interest in selectingthat dose. The prescriber then chooses the prescription instructions.Further details of this process are shown in FIGS. 28F-29C.

[0104] It is not necessary to limit the availability of products to onlythe remote dispenser 3000 located at that particular HCF. The computer4300 is able to indicate current inventory status of all remotedispensers 3000 because the sync process has given it extremely timelyinventory information from the central server 2000 by way of the HCFworkstation 4200. The prescriber may then determine from the patientwhether the patient desires any of the products available from any ofthe remote dispenser(s) 3000 convenient to the patient's currentlocation, or home, or other eventual destination. If so, the prescribernotes this on the computer 4300 so that a voucher may be generated. Ifnot, the patient is given the option of receiving a printed traditionalprescription that may be taken to a pharmacy of the patient's choice, orif the patient identifies a particular pharmacy to receive it, theprescription may be transmitted directly to that pharmacy by facsimile,e-mail, or other communications channels. In another example use of thepresent system, the prescriber gives a voucher to the patient and thepatient takes the voucher to the dispenser. The patient can then makethe decision at the dispenser whether to receive the product from thedispenser or to get a printed copy of the prescription.

[0105] Regardless of the choice, a final synchronization of the computer4300 to the HCF workstation 4200 or central database server transfersthe data to the HCF workstation 4200, the central system 2000, and theremote dispenser 3000 as appropriate. It is preferred but not requiredthat this final synchronization also include updating the computer 4300with not only the current inventory levels of the remote dispenser 3000in the local HCF, but also the information pertinent to the nextpatients registered or scheduled to be seen by prescribers at the HCF.

[0106] Patient Discharge Process

[0107]FIG. 6 illustrates the patient discharge process in more detail.The HCF staff receives information on the prescription or voucher fromthe printer 4100. In one embodiment, the staff determines if there areany outstanding issues remaining from the adjudication process. If so,it may be possible to modify the transaction to permit re-adjudication,or if not the transaction is modified into a traditional prescriptionthat cannot be filled by any of the remote dispensers or communicated toa pharmacy of the patient's choice via facsimile, e-mail or other formsof communication. Alternatively, as noted above, the call center 9050(FIG. 1) will handle any adjudication issues. Either the traditionalprescription or the adjudicated prescription (in the form of a voucherprinted at printer 4100 and redeemable at the remote dispenser 3000) istaken to the examination room and presented to the patient after anyoutstanding questions from the patient are answered. Or, if the HCFprefers, the patient may receive either document upon leaving the HCF.Alternatively, as noted above, the patient may receive the prescriptionfrom the printer on the dispenser.

[0108] Prescription Modification Process

[0109]FIG. 7 illustrates the process of modifying an establishedprescription. To void an established prescription entirely, the entry isretrieved from the HCF system, a “void” option is recorded, and allpaper documentation of the prescription is manually discarded. Additionsor changes to an existing prescription are also entered on the HCFsystem.

[0110] Stock Ordering Process

[0111]FIG. 8 illustrates the process of ordering stock (either productsuch as prescription drugs, or over-the-counter drugs, or supplies suchas labels and printer paper) for each remote dispenser 3000. Because allinventory data is maintained on the central server 2000, this process isexecuted there. In accordance with well-known inventory controlprinciples, reorder points (quantities and/or dates to triggerreordering) are maintained for every stock item. When the actualinventory levels identify those stock items that are at or below theirreorder points, orders for such items are generated and transmitted toappropriate fulfillment vendors. The central server provides orders foreach HCF in addition to an aggregate order to the fulfillment vendor(which for example, may be the HCF's own pharmacy, a repackager, abottler, a mail-order system, etc.). The fulfillment vendor processesthe order and ships the new stock to each individual HCF, even if theorders of each HCF have been aggregated together into a common ordersent by the central server 2000. Personnel at each HCF or centralpersonnel are responsible for restocking each remote dispenser 3000, andfor returning any replaced or overstocked items, both as described inmore detail below. Each remote dispenser 3000 automatically transmitsupdated inventory data to the central system 2000 where a reconciliationprocess identifies whether there are any discrepancies betweenanticipated and actual amounts and locations of each item. If there arediscrepancies, they are identified and the HCF or vendor or both arenotified so that all discrepancies may be resolved.

[0112] Restocking Process

[0113]FIG. 9 illustrates in more detail the process of restocking eachremote dispenser 3000. When new items arrive at the HCF, the remotedispenser 3000 is put into restocking mode, which is preferablyaccomplished by entering a specific security code, which if valid,activates the manager module to contact the central system for the mostrecent data relevant to the restocking process. Once the security codeis validated and the data is received, the portion of the remotedispenser 3000 dedicated to product inventory is unlocked and availablefor access. The first main task is to remove magazines that have beenidentified by the manager as empty of product, discarding the emptymagazines themselves. Next, magazines that have been identified by theremote dispenser 3000 as containing products to be returned are removed.The individual products are removed from the magazines and returned,while the emptied magazines are discarded or returned. Then, magazinescontaining new supplies are installed as required.

[0114] Once the portion of the remote dispenser 3000 containing theproducts is closed and locked, the manager module 3200 scans allmagazines to confirm whether all empty magazines and all magazinescontaining products to be returned have been removed, and it checks thatall new magazines have been properly inserted. If not, the restockingprocess is not complete and must be re-performed. If so, datarepresenting the current inventory levels and the inventory transactionsthat have just occurred is transmitted to the central server. Once thisis complete, the visual display 3450 confirms completion of a successfulrestocking process. As noted above, the system rescans each slot afterthe product has been loaded and performs an update of the position ofeach product. This provides a fool-proof, safe system since a givenproduct can be placed anywhere within the dispenser and the rescanningprocess will automatically update the product's position, thus notrelying on any human interaction. Moreover, the FDA-approved bottler orrepackager provides a trusted product.

[0115] Prescription Dispensing Process—Overview

[0116]FIG. 10 illustrates the basic process by which a patient has aprescription filled by remote dispenser 3000. In the patient dischargeprocess, the patient either received a voucher for a product located inthe remote dispenser 3000, or they may exchange a traditionalprescription for such a voucher (or vice versa). Once in possession of avoucher, the patient begins by selecting a language in which theremainder of the exchange with the remote dispenser 3000 will takeplace. Then the patient enters the unique voucher number printed on thevoucher along with patient authorization data (such as birth day andbirth month, but this is only an example). In one option, the voucherincludes a bar code having all the necessary information and that can bescanned by the dispenser. The manager module 3200 determines whether thevoucher number is valid and if so whether it properly correlates withthe authorization data that the patient has entered. If not, the entryprocess is repeated in case erroneous data has been entered throughsimple human error. At this or at any other point in the process priorto acceptance of the entire voucher-based transaction, there is anoption to cancel the voucher-based transaction and print a traditionalprescription on printer 3950 for the patient. A further option, asdiscussed above, is to provide a camera to take a picture of the patientor a picture of an I.D, or other security measure such as a retinalscan.

[0117] Once a valid voucher and set of authorization data have beenentered, the visual display 3450 shows a summary of existingprescriptions to be filled and a selection of possible over-the-counter(OTC) products that may be dispensed from remote dispenser 3000 withouta prescription. The patient selects which if any products they wish toreceive from remote dispenser 3000. The patient purchases theirselections by passing a credit card through credit card reader 3850, ordepositing cash, or using the check reader, or using a cell phone IRfeed, or any other cash, check, debit, or electronic payment method.Manager module 3200 receives data from the credit card (or check, etc.)through credit card reader driver 3800 and transmits it to centralserver 2000 so that the transaction may be conducted with credit cardserver 6000 (or check server, etc.) in a well-known manner. As is commonin the art, this may involve a repeated entry of credit card data by thepatient for a variety of well-known reasons. Once the paymenttransaction is authorized, manager module 3200 directs dispenser module3100 to dispense the proper products. Manager module 3200 then prints areceipt and patient information, drug education information, ads,coupons, or marketing information on printer 3950 for the patient totake with them along with their products. Manager module 3200 then sendsupdated inventory and transaction data to central system 2000. As notedabove, during the process, the phone on the dispenser can be used totalk to someone at the central control or to a pharmacist. Moreover,after the prescription has been filled and if there are refills on theprescription, a menu on the screen can be provided to allow the patientto have the refills transferred to a pharmacy of their choice.

[0118] Remote Dispenser

[0119] As shown in FIG. 11 and FIG. 12, the remote dispenser 3000consists of a control module 102 and a cabinet module 104. Optionally,the control module and cabinet module may be housed in a single cabinet.The basic configuration includes one control module and one cabinetmodule. Alternatively, an additional cabinet module may be added forincreased drug storage capacity.

[0120] The control module 102 houses subsystems that provide theinterface between the remote dispenser 3000 and the medical patient.These components include a 17 inch Monitor with touch screen 202, acredit card reader 204, a prescriptions/instructions/receipts printer206, a prescription/instructions/receipt output slot 208, an internalwaste slot/waste basket 210, speakers 212, and a controller PC 214.

[0121] An example of hardware and software that are suitable for thecontroller PC 214, which is located in the control module, is a DellOptiPlex GX110 Mini-Tower having the following specifications: GX110Pentium III processor, 500 MHz, 512 half speed cache & Integrated NIC;Memory: 128 MB Non-ECC SDRAM (ID IMM); Keyboard: Quietkey (Space saver);Video Solution: Integrated Intel 3D graphics with Direct AGP and 4 MBDisplay Cache; Hard Drive: 10GB EIDE (7200 RPM); Floppy Drive: 1.44 MB3.5″; 4 (Min) PCI/ISA Slots; 2 (Min) serial ports; Dimension: Tower withMax size: 18″ H×17″ L×8″ W; Extra Parallel Port Card; Sound Card: SoundBlaster Audio PCI (64 Voice), use with CD, DVD or CD-RW; CDROM; NetworkCard: Integrated 3Com EtherliNk 10/100 with ACPI and Remote Wake-upOnly; and Operating System: Windows NT 4.0 Workstation SP5 with CD usingNTFS. Other generally equivalently performing hardware and softwarecould be substituted in a known manner without limiting the scope of theinvention. In accordance with known principles, the design of the systemshould be such that the system functions are not dependent upon theparticular hardware or software selected for implementation, thuspermitting the system to migrate to other hardware or software platformswithout any change in the scope of the invention.

[0122] The credit card reader/acceptor 204 is preferably from IDTechCompany. Other generally equivalently performing hardware and softwarecould be substituted in a known manner without limiting the scope of theinvention.

[0123] The prescription/instruction/receipt printer is preferably aDatamax Ovation 2!, Direct Thermal Printer, and is located in thecontrol module. The printer uses the same paper to print prescriptions,instructions and receipts on 4″×5″ sheets. The patient informationsheets are automatically trimmed to the proper length. The printer alsoprints product return packing slips and miscellaneous inventorytransaction reports.

[0124] The remote dispenser 3000 is equipped with a temperature sensingsubsystem (not shown) having both over temperature and under temperatureset points. The central server is alerted if the temperature exceeds theset points.

[0125]FIG. 12B shows an automatic dispenser 3000B according to oneembodiment. Dispenser 3000B includes many of the features discussedabove for dispenser 3000 and certain details will be omitted for sake ofclarity. Dispenser 3000B includes a flat screen monitor 202B located onthe front door 290 of the dispenser 3000B. In this example, front door290 swings open to expose the product cabinet module located behind thedoor. Dispenser 3000B also includes a telephone 288, an electronic lock280, a prescription receptacle 282, a credit/debit card reader 204, acheck reader 284, a cash deposit 286, and a change return 292.

[0126] As shown in FIG. 13, prescription drug products are stored in thecabinet module 104 in pre-filled magazines 106 that rest on shelves andsurround cantilevered lead screws 130. The products are delivered toremote dispenser 3000 in the pre-filled magazines 106 and dispensed fromthe magazines. A cabinet 108 encloses the cabinet module 102. Thecabinet module stores product prior to dispensing and has a hinged door.The cabinet module also encloses the gantry transport system 110,product rotator 118, label printing system 122, and an uninterruptiblepower supply (UPS) (not shown). The UPS allows the remote dispenser tocontinue to function, in the event of power loss, long enough tocomplete any vending operation currently in progress and to achieveproper shutdown of the computer system.

[0127] The cabinet encloses a gantry system 110 that is used to positionan end effector 112 and a magazine scanner 114, preferably a singledirectional scanner from PSC Company, model #LM520 single line laserscanner. Optionally, the remote dispenser may utilize a handheldscanner. The hand held scanner is stored inside the remote dispenser andmay be used during restocking product.

[0128] The end effector 112 includes a product catcher 116 thattransports the product from the magazines to a product rotator 118. Theproduct rotator rotates the product for bar code reading by the bar codereaders 120, 121 and application of the label by the label printer 122.

[0129] Bar code reader 120 is preferably an Omni directional scannerfrom PSC Company, model #VS800 Omni-directional laser scanner. TheOmni-directional scanner 120 is located in the cabinet module and scansbarcodes on the sides or bottom of product. Bar code reader 121 ispreferably a single directional scanner from PSC Company, model #LM520,single line laser scanner. Bar code reader 121 is used to scan the sideof product while in the product spinner.

[0130] The label printer 122 is preferably a Datamax Ovation 2! having athermal transfer ribbon attachment. Optionally, the printer may use adirect thermal technique. The label printer prints 2″×4″ prescriptioncontainer labels with bar codes and is compatible with the labelapplicator.

[0131] After the product is labeled, the product is dispensed throughthe product chute 124 by activating the chute door motor 126 or if theproduct is rejected it is sent to the reject bin 128. The product chuteallows the labelled drug to be delivered to the patient at the remotedispenser, while preventing any individual from reaching into the chuteto the point of being injured. Additionally, the control module is in alocation proximate to the product chute where the product is dispensedto the patient.

[0132] The reject bin is a receptacle which stores products that do notpass the bar scan checks. The packages are later removed and returned tothe vendor.

[0133]FIG. 14 shows an exploded perspective view of the magazine andlead screw system 129. The cantilevered lead screws 130 are mounted tothe inside back panel 132 of the cabinet module 104. In one example, themagazine 106 is mounted on the lead screw 130. Alternatively, a shelf isprovided for the magazine to rest on. The magazine cartridge consists ofa cardboard outer shell 132 and a vacuum molded inner portion 134. Theproduct 136 is stored within the magazine 106. A pusher 138 for movingthe product is threaded on the lead screw. The lead screw and pusher aremechanical elements designed to support the magazine within the cabinetmodule and to dispense product from the magazine. The lead screw is athreaded rod which, when rotated, causes the pusher to advance. Thepusher is used to advance the product within the magazine assemblyduring the dispensing process. The magazine itself contains the productfor a given magazine position (one specific product for a givenposition).

[0134] The magazine is a container that serves the dual purpose of ashipping carton and product-dispensing magazine. The magazine caninclude three principle components: a corrugated (cardboard) paper outershell 132, a vacuum-molded plastic inner liner portion 134, and a barcode label 135 placed on the outboard end of the magazine. The outershell is a tube designed to support the inner portion during shippingand handling and during application inside the remote dispenser. Theinner liner portion is designed to prevent the product from changingorientation during shipping and handling, as well as to align themagazine to the lead screw and to guide the products during thedispensing process. The bar code label is used to identify the contentsof the specific magazine so that the appropriate preprogrammeddispensing procedure is affected. If the magazine rests on a shelf, theliner 134 can be omitted. The exterior surface of the magazine may alsocontain a legible label stating the drug product content of thatmagazine. However, the barcode label 135 on the outside of the magazinemay have the drug product name printed in English (or other language) inaddition to the barcode or the product package is readable within themagazine.

[0135]FIG. 15 is a front view of the gantry transport system 110. Thegantry transport system 110 is a two-dimension robotic assembly used toposition the end effector 112 at a given magazine position.Additionally, the gantry system transports the product from the magazineto the product rotator and label printer and also positions the magazinescanner 114.

[0136] The gantry transport system 110 includes an x-axis system 142 andan y-axis system 144. The x-axis system moves the y-axis system and theend effector 112 from side to side, while the y-axis system moves theend effector 112 up and down. The x-axis system includes an x-axisbelt/cable 146, x-axis pulleys 148, and an x-axis motor system 150. Thex-axis system consists of a belt 146 looped around pulleys 148 and acable 146 looped around idler pulleys 148. The motor system 150 consistsof a motor, gearbox power supply and controller. As the controllersignals the stepper motor, the motor repositions the belts and cablesand moves the y-axis system from side to side.

[0137] As shown in FIG. 16, the y-axis system consists of an y-axisbelt/cable 152, y-axis pulleys 154, and an y-axis motor system 156.

[0138]FIG. 17 is a cross sectional view of the y-axis transport system.The y-axis system is supported on a frame structure 158. The framestructure consists of a Lexan rail 160 affixed to an aluminum tube 162.Guide wheels 164 aligned the y-axis system along rail 160.

[0139]FIG. 18 is a perspective view of end effector 112. The endeffector is a mechanical device mounted on the gantry transport systemand is used to retrieve and transport the product during the dispensingprocess. The end effector 112 includes the magazine bar-code scanner114, a drive screw motor 166, a lead screw coupler motor 168, an opticalsensor 170, a mounting plate 172, and a product catcher 174. The leadscrew coupler motor 168 advances a drive adapter (not shown) to coupleto the lead screw. Optical sensor 170, upon detecting the “fall” of aproduct into the product catcher, signals the lead screw drive motor tostop advancing the product out of the magazine tube. The product catchercaptures the product as it is advanced out of the magazine. The productcatcher includes a stationary mitt 180, and outside moveable mitts 176,178. In some examples, the drive screw is omitted and each of the leadscrews 130 is driven by a separate motor associated with each lead screwand controlled by the dispenser's controller.

[0140]FIG. 19 shows a side view of product rotator 118. The productrotator serves the function of spinning the product in the barcodescanner beam, so that the product can be identified, and rotating theproduct as the product label is applied. The product rotator 118consists of two rotating disks 182, one of which is mounted to atraveling arm 184 that is actuated by a screw 186 that is driven bymotor 188. When the package is transferred to the product rotator, thetraveling arm 184 is moved inward, the disks are brought together, andthe package is captured between the disks. A second motor 190 then actsvia a second screw to position the entire rotator mechanism under thelabel printer. A third motor 192 spins the disks and rotates the packageto effect label application. The traveling arm 184 moves along rails 194on guide wheels 196.

[0141]FIG. 20, shows an end view of the product rotator 118 showing thepositioning of motors 188, 190, and 192 and the positioning of rails 194and guide wheels 196.

[0142]FIG. 21 shows a perspective view of label printer 122. The printermechanism 197 generates an adhesive-backed package label 198 andadvances the label toward a transfer wheel 199. The label 198 is held onthe surface of the transfer wheel 199 by vacuum (adhesive side of labelis outward) while the drive motor (not shown) advances the transferwheel. A solenoid 195 retracts and allows the transfer wheel to swing tothe product rotator 118 for label application. The label makes contactwith the product package while the product rotator spins the package atwhich point the label adheres to and is transferred to the package. Asthe product spins, wheel 199 is supported by the product itself. Assuch, the wheel can accommodate almost any shape of box, bottle, orother item that needs labeling. In various embodiment, other types oflabelers can be used including, adhesive labelers, etc.

[0143] As shown in FIG. 13, one of bar-code scanners 120, 121 is used toscan the pre-labeled product to verify that it is the right product. Ifnot, the product is sent to reject bin 128 (FIGS. 13 and 22C). Also,after the product has been labeled by the labeling system 199, one ofscanners 120, 121 scans the label. Again, if it is mislabeled, theproduct is sent to the reject bin. Accordingly, to dispense aprescription product from the present system, the system requires theproduct to go through three scans. First, the magazine is scanned toidentify the magazine holding the product, then the product itself isscanned, finally the labeled product is scanned. This triple checkprocess is rigorous enough to satisfy some current state laws fordispensing prescriptions. Moreover, it is anticipated that most stateswill allow use of the system once a state review board has reviewed theprocess. Accordingly, the present system provides a safe system for thedispensing of prescriptions without the intervention of a pharmacist, orany human intervention at all.

[0144] FIGS. 22B-22C show a product transporting system according to oneembodiment. This embodiment includes some of the same features asdiscussed above for FIGS. 13-22 and some details are omitted for sake ofclarity.

[0145]FIG. 22B shows an end effector 112B and a product rotator 118B. Inthis example, end effector 112B includes a product catcher 174B thatincludes a V-shaped cross-section. A product that falls into catcher174B is prevented from falling off of the catcher by a gate 175. Gate175 includes a first side 179 which is rotatably coupled to the endeffector 112B using a pivot bar 177. The main body portion of gate 175covers the outer, open end of catcher 174B. A second end 183 of gate 175is positioned to abut wheel 182A of product rotator 118B when the endeffector is brought into position proximate the product rotator 118B.For example, as the end effector 112B is translated towards productrotator 118B, wheel 182A lifts gate 175 until the end effector islocated such that wheels 182A and 182B are approximately aligned oneither end of the product which is lying on the bottom of V-shapedcatcher tray 174B. Then as described above, motor 188 drives screw 186to bring wheel 182A towards wheel 182B until the product is held betweenthe two wheels. In this embodiment, wheel 182A is smaller than in theprevious example. This allows the wheel to clear the catcher as ittravels over the catcher to grasp the product.

[0146]FIG. 22C shows a product delivery chute 302 according to oneembodiment. Product delivery chute includes a product holding portion304 and a product delivery portion 306. These two portions 304 and 306are separated by a movable member 308. Movable member 308 acts as thefloor of holding portion 304. As products are labeled by the system,they are dropped into holding portion 304. After all the products for apatient have been prepared, an actuating member 181 (See FIG. 22B) onend effector 112B contacts and activates a mechanism 310 that opensmovable member 308, thus allowing the products to fall into productdelivery portion 306. Product delivery portion 306 is in opencommunication with the reach-in slot 312, allowing the patient to pickup their products. This two-step delivery process keeps all the productsin one place until they are presented to the patient. Thus, a patientwon't grab the first one out and forget to take the rest.

[0147] Product Dispensing Process

[0148] The dispensing process will not initiate until the patient (orHCF staff, or other authorized user) has entered all requiredinformation and the cash, check, credit card, and/or insurance payment(if necessary) has been verified for inputs required to allow drugs tobe dispensed.

[0149] In one embodiment, referring generally to FIGS. 13-22, thesequence of events in dispensing a product is as follows:

[0150] 1. The x- and y-axis gantry motors position the end effector inthe correct magazine location. The lead screw positioner motor extendsthe coupler on the end effector toward the mating coupler on the leadscrew, until the two couplers are intermeshed but not in contact, whichprevents excessive loads from being transmitted to the cantilever leadscrew assembly. A load sensor (e.g. a spring and a proximity sensor) isused to apply a known tip load on the cantilever lead screw assembly.The x- and y-axis gantry motors are then powered down to eliminateadditional forces being exerted. The drive screw motor 166 then engagesthe coupler until the sensor detects the necessary load, after which they-motor is powered up and lifts the end effector a pre-calculated numberof steps to unload the lead screw bearing. In an alternative embodiment,each lead screw has a motor attached thereto and the system turns oneach motor as necessary to advance the pusher and dispel the product.

[0151] 2. The drive screw motor 166 rotates the spring-loaded conicalcoupler/lead screw, advancing the pusher to dispense the product intothe catcher of the end effector.

[0152] 3. An optical sensor, positioned to detect the product as itfalls into the catcher, signals the drive screw motor to stop advancingthe product.

[0153] 4. The product is transported via the end effector to the productrotator, where telescoping catcher is compressed by the product rotator.At the same time the product is then grasped and held between tworubber-faced disks, one idler and one driver disk.

[0154] 5. The clamp pressure is controlled by presetposition/calibration of a proximity sensor and compression springdisplacement.

[0155] 6. The product rotator rotates the package until scanned toverify that the correct drug is being dispensed. If the scan issuccessful, the remote dispenser completes steps 7 through 10 below. Ifthe scan is not successful, the product is dropped into the reject binand the process returns to step 1. If the scan reveals that the correctdrug is not being dispensed, the magazine location is recorded, the HCFis alerted, and the process returns to step 1 at another magazinelocation for the same drug.

[0156] 7. The label printer generates an adhesive-backed package labeland advances the label toward the transfer wheel. On example provides alabeling system which attaches in part via static electricity.

[0157] 8. The label is held on the surface of the transfer wheel byvacuum (adhesive side of label is outward) while the drive motoradvances the transfer wheel. A solenoid retracts and allows the transferwheel to swing to the product rotator for label application.

[0158] 9. The product rotator spins the package and the label on theroller is lowered onto the product package at which point the labeladheres to and is transferred to the package.

[0159] 10. The scanner checks the applied label to verify that the labelwas applied properly.

[0160] 11. A flapper moves to divert the labeled package into thedispensing chute.

[0161] 12. The rotator disks retract allowing the package to drop, andthe product is directed to the package output portal of the remotedispenser.

[0162] In another embodiment, referring generally to FIGS. 13-22, and22B-22C, the sequence of events in dispensing a product is as follows:

[0163] 1. The x- and y-axis gantry motors position the end effector inthe correct magazine location. The lead screw positioner motor extendsthe coupler on the end effector toward the mating coupler on the leadscrew, until the two couplers are intermeshed but not in contact, whichprevents excessive loads from being transmitted to the cantilever leadscrew assembly. A load sensor (e.g. a spring and a proximity sensor) isused to apply a known tip load on the cantilever lead screw assembly.The x- and y-axis gantry motors are then powered down to eliminateadditional forces being exerted. The drive screw motor 166 then engagesthe coupler until the sensor detects the necessary load, after which they-motor is powered up and lifts the end effector a pre-calculated numberof steps to unload the lead screw bearing.

[0164] 2. The drive screw motor 166 rotates the spring-loaded conicalcoupler/lead screw, advancing the pusher to dispense the product intothe catcher of the end effector.

[0165] 3. An optical sensor (or other sensor), positioned to detect theproduct as it falls into the catcher, signals the drive screw motor tostop advancing the product.

[0166] 4. The product is transported via the end effector to the productrotator, where one wheel of the product rotator lifts the gate on thecatcher and then the product is grasped and held between tworubber-faced disks or wheels, one idler and one driver disk.

[0167] 5. The clamp pressure is controlled by presetposition/calibration of a proximity sensor and compression springdisplacement.

[0168] 6. The product rotator rotates the package until scanned toverify that the correct drug is being dispensed. If the scan issuccessful, the remote dispenser completes steps 7 through 10 below. Ifthe scan is not successful, the product is dropped into the reject bin128 and the process returns to step 1. If the scan reveals that thecorrect drug is not being dispensed, the magazine location is recorded,the HCF is alerted, and the process returns to step 1 at anothermagazine location for the same drug, if any. Otherwise a prescription isgenerated.

[0169] 7. The label printer generates an adhesive-backed package labeland advances the label toward the transfer wheel. (O.T.C. products andwater for reconstitution do not need to be relabeled).

[0170] 8. The label is held on the surface of the transfer wheel byvacuum (adhesive side of label is outward) while the drive motoradvances the transfer wheel. A solenoid retracts and allows the transferwheel to swing to the product rotator for label application.

[0171] 9. The product rotator spins the package and the label on theroller is lowered onto the product package at which point the labeladheres to and is transferred to the package.

[0172] 10. The scanner checks the applied label to verify that the labelwas applied properly.

[0173] 11. If the label is correct, the product rotator moves so thatproduct is over the dispense chute.

[0174] 12. The rotator disks retract allowing the package to drop andthe product is directed to the product holding area.

[0175] 13. When all products have been delivered to the product holdingarea, the gantry moves and causes the catcher to actuate the floor ofthe holding area to release products to the output portal or deliveryportion of the dispenser.

[0176] Stocking/Restocking Process

[0177] Upon sending a new shipment of drugs to the remote dispenser, theproduct supplier also sends an electronic file, referred to as theproduct file that contains data on the contents of the shipment.

[0178] Preparing the remote dispenser for restocking consists of one ormore of the following steps: a) Inserting a security code and having thecode validated by the central server, b) Opening the cabinet door afterusing the electronic lock, c) Scanning the shipper bar code located onthe outside of the shipping carton (or on the packing slip), d)Displaying the descriptions and locations of magazines to be removed andreturned to the vendor including magazines that are empty or products tobe returned for various reasons, e) Removing all empty magazines, f)Removing magazines listed on the display and scanning the magazinebarcode, g) Indicating if the correct magazine was removed, h)Displaying the status of the magazines by color, i) Scanning the barcodeof each package from the return bin that is to be returned to the vendoras well as any packages that have fallen from the magazine to the bottomof the remote dispenser, or alternatively just returning the packagesunscanned, j) Keying barcodes for packages that will not scan properly,k) displaying all scanned and keyed return products, l) Placing returnproducts in a return shipping carton, m) printing a packing slip ofreturn items and placing the packing slip in the return shipping cartonfor shipping to the vendor or to the HCF pharmacy, and n) sending anelectronic soft copy of the packing slip to the central server.

[0179] The process of refilling the remote dispenser consists of one ormore of the following steps: a) Displaying the magazines in the newshipment, b) Scanning the barcode on each magazine from the newshipment, the barcode indicating the contents of the magazine, c)Displaying an indication that the magazine was received, d) returningunreadable or unlisted magazines to the vendor, e) loading the newmagazines into any refill location, f) guiding the new magazine onto thelead screw at the refill location, g) pushing the new magazine fullyonto the lead screw assembly, h) closing the cabinet door, and i)automatically scanning the barcodes at the front of each magazine toconfirm placement and location.

[0180]FIG. 22 shows another embodiment of the present invention. Amoveable printer 500 moves on the gantry transport system 110 asdiscussed above. The printer 500, such as an inkjet printer, directlyprints on the package 136 or directly prints on a label 510 that isattached to the package 136. The packages 136 are stored in magazines132 as discussed above. The package 136 is positioned at the end of themagazine to allow the printer to print on the label 510 on the product.Once the printing is complete the product is dispensed to the patient.

[0181] PDA Prescription Entry Program

[0182] The PDA Prescription Entry System allows new prescription entryusing personal defaults, new prescription entries needing customization,new pediatric prescriptions, viewing, revising or deleting prescriptionsalready written, and revising a prescription when the insurance deniesthe prescription. The entry system is operated using the control buttonson the bottom edge of PDA 4300. As shown in FIGS. 23-30, PDA 4300includes a back button 4310, a tab button 4320, a scroll button 4330, anenter button 4350, and a cancel button 4340. Tab button 4320 is used totab between screens. Cancel button 4340 is used to cancel or go back onefield. Scroll button 4330 is a bi-directional button and is used toscroll up and down. Enter button 4350 is used to enter and to move tothe next field. A hotsync button on the PDA cradle is used to provide ahotsync between the PDA 4300 and another device.

[0183] FIGS. 23-30 show exemplary screens of one embodiment of the PDAPrescription Entry Program. Although shown on a PDA, in one or moreembodiments, the following system can also be incorporated into a laptopor desktop computer.

[0184]FIG. 23A shows an exemplary screen for new prescription entry. Theuser chooses whether to display all patients or just patients to be seenby the user. The preference is stored for the next time a prescriptionis written. The user scrolls down using scroll button 4330 to the firstletter of the patient's last name and presses enter button 4350. Theuser optionally may tab to another screen while writing the prescriptionand return later to finish the prescription at the point where the userleft off. When the HCF name 4360 has a gray background, there areprescriptions to upload. When the rejected tab 4370 has a graybackground an insurance rejection has been received.

[0185]FIG. 23B shows an exemplary screen for choosing a patient for anew prescription. The user scrolls through a patient list using scrollbutton 4330 to select a patient name. At either the top or the bottom ofthe screen scrolling begins one screen at a time. At the first change ofdirection, scrolling begins one patient name at a time. A new patient'sname may be entered by pressing enter button 4340 on the dotted line.

[0186] If pediatrics mode is toggled on, the program defaults to pop upa window to enter the weight if the weight is not shown. For example, atscreen 23D, the user can be given a choice between pediatricscalculation mode or regular mode. If regular mode is chosen the programgoes to screen 23E and a default prescription is shown. If pediatricsmode is chosen the program goes to screen 28E.

[0187]FIG. 25C shows an exemplary screen for picking a quantity for anew prescription. The user uses scroll button 4330 to scroll down topick a quantity from the list of quantities. Optionally, the quantitiesare listed in the order of those most commonly written. The listincludes a designation, such as a “D” after those quantities availablein the remote dispenser. In one example, a “+” sign denotes that theproduct is in the dispenser and a “−” denotes that the product isusually in the dispenser, but is out of stock. Blank means the productwas not ever in the dispenser. The cursor automatically highlights theclosest larger quantity available based on the dosage and length of timeto take the medication entered by the user. Optionally, the user mayhighlight a different quantity or enter a new quantity by pressing theenter key when the dotted line is highlighted.

[0188]FIG. 25F shows a screen for choosing how to dispense theprescription. The user may choose between having a written prescriptionprinted out at the dispenser in the waiting room, a dispenser at aremote location, or have the prescription drugs dispensed at the remotedispenser, automatically fax or e-mail the prescription to the patient'spharmacy, or completely cancel the prescription.

[0189] FIGS. 28F and so on show one embodiment of pediatricscalculations mode. As noted above, in this mode the prescriber will beprompted to enter the patient's weight. After that, the daily dose isselected. As the prescriber adjusts the daily dosage, the systemautomatically calculates the exact dosage (in units per day). Theprescriber then chooses the form and strength of the drug (if theprescriber selects a dose that exceeds the maximum recommendeddose/m/k/day, they will be prompted to answer a question confirmingtheir interest in selecting that dose. The prescriber then chooses theprescription instructions.

[0190] All these examples shown allow a user to write a prescriptionwithout using any writing input into the PDA (for example using the“Graffiti” text input function on a Palm PDA). The user can write acomplete prescription just using the buttons on the bottom of the PDA tofind and select the proper values for various parameters. This allowsquick and painless prescription preparation. Also, the user does havethe option of “graffiti” writing in some values if they want to make achange.

Additional Embodiments

[0191] Referring now to FIG. 31 there is illustrated still anotherexample embodiment of a method according to the present invention. Inthis embodiment, a medical service provider 9002 prescribes a medicationfor a patient. Such prescription may be conveyed from the provider 9002to a pharmacy service provider 9006 either as written instructions on apaper slip 9004, called into the pharmacy service provider 9006 by theprovider 9002, or otherwise conveyed such as by facsimilie or using anelectronic medium like e-mail or other electronic transfer. Theprescription is thus presented to the pharmacy service provider 9006 inoral or written (paper or electronic) form. The pharmacy serviceprovider 9006 then enters data about the prescription into a data inputdevice 9008 that relays the data to a medication dispensing machine9010, for example, any one of the embodiments described with respect toFIGS. 1-30 hereinabove. The dispensing machine 9010 automaticallyprepares a medication 9012 by preparing a container 9014 holding themedication wherein the container is automatically labelled 9016 withinformation specific to the patient by the dispensing machine. Suchinformation typically includes the patient's name and the medicationdosing and schedule. Further according to this embodiment, thedispensing machine 9010 is located remotely from the location of theprescribing medical service provider 9002.

[0192] According to another example embodiment of this method, themedication is automatically labelled by the dispensing machine 9010 atthe time that the patient picks up the medication. In particular, it islabelled after the patient arrives at the location of the dispensingmachine. According to another example embodiment, the medication isautomatically labelled by the dispensing machine 9010 prior to the timethe patient arrives at the location of the dispensing machine to pick upthe medication. According to another embodiment, prior to or afterarrival at the site of the dispensing machine 9010 the patient isprovided with a code (for example an alphanumeric code 4-10 digits long)and the patient enters the code into an input device 9018 on thedispensing machine to obtain the labelled container. In one example,this can happen if a patient calls to request a refill by phone or overthe Internet. As discussed above, the user has payment options such asusing a check reader, cash, credit, debit cards, insurance, etc. Also,in one example, if the machine is in a store, the user can pick up thedispensed product and pay at a cashier.

[0193] According to still another embodiment shown in FIG. 32, a controlsystem 9009 for the dispensing machine 9010 is networked with a pharmacymanagement software system 9020 over a network 9022, which may includein part a local area network and a wide area network such as theInternet or a virtual private network, or satellite link, for examplebut not by way of limitation.

[0194] According to another example embodiment as illustrated in FIG.33, the medical service provider 9002 is located in an HCF or medicalservice facility 9024, and the dispensing machine is in a location 9026that is not co-located with the facility or at location 9024. Themedical service facility may be, for instance but not by way oflimitation, a doctor's office, medical HCF or hospital, and the location9026 can be a pharmacy located, for example, off-site in theneighborhood or facility complex, or many miles away in a drive thruwindow or virtually any location.

[0195] According to still another example embodiment of the inventionillustrated in FIG. 34, there is provided a method for dispensingprescribed medications. In this embodiment, a prescribing medicalservice provider 9032 prescribes a medication for a patient 9034. Dataabout the prescription is entered into a data input device 9036 thatrelays the data to a medication dispensing machine 9038, for example,any one of the embodiments as described hereinabove in FIGS. 1-30. Inone example, the dispensing machine 9038 can automatically prepare themedication for the patient by labelling 9040 a container 9042 of themedication with with patient-specific information 9044. Alternatively,the labeling can take place after the patient enters the properinformation and payment (if any) into the dispenser. In this embodiment,the dispensing machine 9038 is located remotely from the location 9036of the prescribing medical service provider 9032.

[0196] According to one alternate embodiment of the method of FIG. 35,the prescription is presented to the pharmacy service provider 9033orally over the telephone, in written form by presenting it on paper, orin written form by an electronic delivery mechanism. The pharmacyservice provider operates dispensing machine 9038 to enter theprescription.

[0197] According to another example embodiment of this method, themedication is automatically labelled by the dispensing machine 9038 atthe time that the patient picks up the medication. In particular, it islabelled after the patient arrives at the location of the dispensingmachine 9038. According to another example embodiment, the medication isautomatically labelled by the dispensing machine 9038 prior to the timethe patient arrives at the location of the dispensing machine to pick upthe medication. According to another embodiment, the patient is providedwith a code (for example an alphanumeric code 4-10 digits long) eitherprior to or at the time they arrive at the location of the dispensingmachine 9038 and the patients enters the code into an input device 9046on the dispensing machine to obtain the labelled container.

[0198] According to still another embodiment shown in FIG. 36, a controlsystem 9037 for the dispensing machine 9038 is networked with a pharmacymanagement software system 9048 over a network 9050, which may includein part a local area network and a wide area network such as theInternet or a virtual private network, or satellite link, for examplebut not by way of limitation.

[0199] In yet another alternate embodiment as shown in FIG. 37, themedical service provider 9032 is located in a medical service deliveryfacility 9054, and the dispensing machine 9038 is in a pharmacy location9056 that is not co-located with the medical service delivery facility9054. According to this embodiment the medical service facility is, forexample, but not limited to one of a doctor's office, medical HCF orhospital.

[0200] Still another example embodiment of a method according to theinvention is illustrated FIG. 38. In this embodiment a medical serviceprovider 9062 prescribes a medication for a patient 9064, and data aboutthe prescription is entered into a control system 9066 for a medicationdispensing machine 9068. The dispensing machine 9068 automaticallyprepares the medication by preparing a medication container 9070 holdingthe prescription medication wherein the container is automaticallylabelled 9072 with patient-specific information by the dispensingmachine. Further according to this embodiment, the dispensing machine9068 located remotely from the location of the prescribing medicalservice provider.

[0201] According to another example embodiment of this method, themedication is automatically labelled by the dispensing machine 9068 atthe time that the patient picks up the medication. In particular, it islabelled after the patient arrives at the location of the dispensingmachine. According to another example embodiment, the medication isautomatically labelled by the dispensing machine 9068 prior to the timethe patient arrives at the location of the dispensing machine to pick upthe medication. According to another embodiment, the patient is providedwith a code (for example an alphanumeric code 4-10 digits long, or abar-code, or a written prescription, or a voucher) and the patiententers the code into an input device 9074 on the dispensing machine toobtain the labelled container.

[0202] According to still another embodiment shown in FIG. 39, a controlsystem 9066 for the dispensing machine 9068 is networked with a pharmacymanagement software system 9080 over a network 9082, which may includein part a local area network and a wide area network such as theInternet or a virtual private network, or a satellite link, for examplebut not by way of limitation.

[0203] According to another example embodiment as illustrated in FIG.40, the medical service provider 9062 is located in a medical servicedelivery facility 9084, and the dispensing machine 9068 is in apharmacy, or other remote location 9086 that is not co-located with themedical service delivery facility 9084. The medical service facility maybe, for instance but not by way of limitation, a doctor's office,medical HCF or hospital.

[0204] Yet still another embodiment of a method according to the presentinvention is illustrated in FIG. 41. In this embodiment, a medication isordered using an automated order entry system 9102 from a first location9104. An order code 9106 is obtained, for example by the patient or thepatient's representative (which may be a family member or othercare-giver). The order code 9106 is subsequently entered into akeyboard, keypad or other data entry mechanism 9108 (voice recognitionfor instance) in an automatic dispensing machine 9110 in a location 9112geographically remote from the first location 9104. The dispensingmachine 9110 automatically labels a container 9116 of the medication andpresents it for pick-up, for example, with patient-specific information9117. Dispensing machine 9110 may be, in one example embodiment, of thekind described above in FIGS. 1-30.

[0205] Still another example embodiment of a method according to thepresent invention is illustrated in FIG. 42. A written prescription, forexample written or printed on a paper slip 9122, is imaged by an imagingand/or card reader device 9124 at a location 9126 and relayed (forexample over a computer network or phone system) to a location 9128remote from the location 9126 where the image is obtained. A pharmacyservice provider 9130 at the remote location 9128 reads the relayedprescription image or data 9129 and enters the order into a controlsystem 9132 for a dispensing machine 9134. The dispensing machine labelsa container 9136 of the medication and presents it for pick-up.

[0206] In one embodiment, a regular prescription written on aprescription pad (or prepared using the system discussed above) can beprepared using the present system. For example, the imager can belocated on the dispenser. The user puts the written prescription intothe dispenser where it is imaged and the image is transferred to apharmacy service provider located virtually anywhere. The pharmacyservice provider may require the user to provide some ID. The pharmacyservice provider then enters the relevant information, which is thentransferred to the dispenser. The patient can enter any payment (ifnecessary) and the product is labeled and delivered, as discussed above.The dispenser then keeps the written prescription.

[0207] According to yet another example embodiment, the reading orimaging device 9124 is used in addition for reading or imaging aninsurance card 9123 and the data from the card in an image or otherelectronic form is forwarded to a remote pharmacy service provider.According to yet another example embodiment, the insurance card readermay be the same or a different device from the device used to obtain animage or data from a prescription. According to yet another embodiment,a magnetic strip or other type of card reader is used to read aninsurance card. Furthermore, in another embodiment, a user presents acredit card to be read by device 9024, and the credit card data isrelayed both to the pharmacy service provider and to a credit cardclearinghouse for approval of a payment for a medication to be dispensedby machine 9134.

[0208] Another example embodiment of the method according to theinvention is illustrated in FIG. 43. In this embodiment, a prescriptionis obtained in electronic form 9144 from a medical service provider9142. The electronic prescription is presented to a pharmacy serviceprovider 9142 using an electronic delivery system 9144. A dispensingmachine 9146 prepares a container 9148 of the medication and presents itfor pick-up, wherein the container is automatically labeled by themachine 9146 with patient-specific information 9149.

[0209] Another example embodiment of the method of the invention isillustrated in FIG. 44. A pharmacy 9152 is stocked 9154 with a varietyof medications in containers 9156. An automatic dispensing machine 9158is located at the pharmacy 9152. The pharmacy is staffed with pharmacyservice providers 9160 during some but not all hours of a day. At leastsome prescriptions are filled for pharmacy customers at least in part byhand during the hours the pharmacy is open. At least some prescriptionsare filled for pharmacy customers using the dispensing machine 9158during hours in which there are no pharmacy staff available to dispenseby hand. According to one alternate embodiment of the method, thepharmacy service providers 9160 retrieve labelled medication containers9162 from the dispenser for customers during the service providers areworking in the pharmacy, and after the pharmacy staff are no longerworking, the customers 9159 themselves retrieve prescribed medicationcontainers with the prescribed medications from the machine 9158.According to this embodiment, machine 9158 in one example embodimenttakes the form of a machine as described above in FIGS. 1-30.

[0210] Still yet another example embodiment of a method according to theinvention is illustrated in FIG. 45. In this embodiment, a dispensingmachine 9172 is located at a dispensing location 9174. A patient 9176presents a written prescription 9178 for a prescription medication atthe dispensing location 9174. Information from or about the prescriptionis relayed to a pharmacist 9180 located remotely 9182 from thedispensing location 9174 where the pharmacist does not have immediatephysical access to the dispensing location 9174. The pharmacist readsthe prescription, checks the user's ID if necessary, and remotelyoperates the dispensing machine 9172 to cause it to automatically labela container 9184 of the medication with information 9185 specific to thepatient. The patient 9176 obtains possession of the labeled medicationat the dispensing location 9174. In one embodiment, the patient takesthe medication from the machine.

[0211] According to yet another example embodiment of this system andmethod, a reading and/or imaging device is used for reading or imaging apatient insurance card or credit card and the data from the card in animage or other electronic form is forwarded to a remote pharmacy serviceprovider. According to yet another example embodiment, the insurancecard reader may be the same or a different device from the device usedto obtain an image or data from a prescription.

[0212] Referring now to FIG. 46, there is illustrated an alternateexample embodiment of a medication dispensing system according to thepresent invention. The medication dispensing system 9200 includes a cardreader and/or imaging device 9202 adapted to image or read aprescription presented by a patient or the patient's representative. Adata input terminal 9204 receives information concerning the patient forwhom the prescription is written. A medication labeling mechanism 9206is responsive to a control system 9208 and produces labelled medicationcontainers 9210 labeled with information 9212 specific to the patient.The control system 9208 receives instructions from an input terminal9214 located remotely from the dispensing system. According to oneexample embodiment, mechanism 9206 is constructed in accordance withillustrated example mechanisms set forth hereinabove, with respect toFIGS. 1-30.

[0213] According to still another example embodiment of the inventionillustrated in FIG. 47, there is provided a pharmacy configuration 9220.Configuration 9220 includes a store 9222 having an enclosed pharmacyfloor space 9224 that is secured against unauthorized entry. Thepharmacy floor space 9224 further includes a storage or stock area 9226for a medication stock 9228, wherein the medication stock includes avariety of medications. An automatic medication dispensing machine 9230,for example, designed in accordance with any other above-describeddispensing machine embodiment, is co-located with the pharmacy floorspace and is accessible to pharmacy customers at least a portion of theoperating hours of the store. The machine 9230 is adapted to dispenselabelled containers 9232 of medications, wherein the label includespatient-specific information 9233. One or more pharmacy serviceproviders 9238 work in the enclosed floor space 9224 during some but notall hours of a day.

[0214] According to an example embodiment of this configuration, themachine 9230 is positioned next to a configurable wall, gate, window orother structure 9240 that is an adapted so that pharmacy serviceproviders can retrieve labelled medications from the dispenser forcustomers during the period of time the pharmacy is staffed, and so thatwhen the pharmacy is not staffed the customers can retrieve prescribedmedications directly from the machine 9230 without assistance fromon-site pharmacy personnel.

[0215] According to still another example embodiment of thisconfiguration, a remote counseling area 9242 with a telephone or othermeans of electronic communication such as e-mail or a chat room or avideo link, is provided so that pharmacy customers may receive afterhours counseling from a pharmacist in a remote location using thetelephone or other means. According to still another embodiment, asystem self-service station 9246 having a keyboard or keypad, forexample, a printing device and an imaging and/or reading device ispositioned outside the pharmacy floor space to allow a customer tosubmit a prescription or insurance card to a remote pharmacist as forexample described with respect to FIG. 45, and also to enter amedication access code that may be printed for the customer and whichcauses the dispensing machine to dispense an appropriate medication forthe patient.

[0216] According to still yet another example embodiment of the methods,systems and configurations illustrated in FIGS. 30-47, the dispensingmachine is one of the designs described above with respect to FIGS.1-47, and furthermore is adapted to hold approximately up to 1000different medication options allowing a wide range of medicationprescriptions to be filled using the machine. According still further tothis example, any stock in any pharmacy floor space may have a greatervariety of medication options, so that a wider variety of medicationprescriptions can be filled from the floor stock than from thedispensing machine.

[0217] According to yet another example embodiment, the dispensingmachine implemented for the systems, methods and configurations of FIGS.30-47 include a mechanism for obtaining payment from a customer, asdescribed above, for example by credit card, “blue tooth” paymenttechnology, smart card cash card, cash bill changer, check reader, orany other mechanism to obtain payment from a patient. Alternatively,payment for medications may be received by pharmacy personnel or byother store personnel. Furthermore, the patient may use a card scanneror digital camera for I.D. (such as a driver's license).

[0218] Yet still another example embodiment of a dispenser of theinvention is shown in schematic form in FIG. 48. This embodiment isuseful, for example but not by way of limitation, with some or all ofthe systems, methods and configurations described with respect to FIGS.30-47. Dispenser 9250 includes both a mechanism 9252 for labellingmedications per the description provided with respect to FIGS. 130, butfurther includes an internal mechanical storage mechanism 9254, forexample, a plurality of bins each holding one or more labeled medicationcontainer and having a dispensing mechanism, allowing labeled medicationcontainers to be stored temporarily until such time as a patient orpatient's representative enters an access code to retrieve themedication. According to this embodiment, prescriptions may be filledprior to the patient coming to the dispensing machine, so that thelabelling is done in advance and therefore the pick up of the medicationfrom the machine takes less time as the only mechanical functioninvolves picking or selecting the pre-labelled medication for dispensingto the patient. Such storage mechanism, in one example embodiment, is aplurality of bins that the pre-labelled medications can be deposited inafter they are labelled, with a picker or other dispensing mechanismsuch as a solenoid controlled container ejector device or screwmechanism for retrieving or dispensing the pre-labeled medications fromthe bins under computer control. The bar codes of the pre-labelledmedications would again be checked prior to dispensing for qualityassurance purposes.

[0219]FIG. 49 illustrates a dispensing system 9300 according to oneembodiment. System 9300 includes a dispensing machine 9301, for exampleany of the dispensing machines discussed herein. System 9300 alsoincludes a feed mechanism 9304, such as a pneumatic tube device, ascommonly known. In this embodiment, machine 9301 is in a first location9302, which is inaccessible during some hours, for example a pharmacy,clinic, bank, etc. At a second location 9306, a user interface 9308 anda delivery point 9310 are provided. User interface 9308 can include aninput device such as a touch-screen or keyboard. It can also include atelephone, two-way video, and other options discussed above for varioususer interfaces for dispensing machines. It can also include featuresfor allowing payment, such as cash deposit, credit card readers, checkreaders, or an ATM interface, for example.

[0220] Feed mechanism 9304 connects dispensing machine 9301 to deliverypoint 9310 where the user can obtain possession of the product disposedfrom machine 9301.

[0221] In one example use, a user will enter their user information(such as voucher number or other authorization code) and financialinformation (if necessary) at user interface 9308. The dispenser willact as described above, preparing and labeling the product, then arobotic arm or other means will deliver the product to feed mechanism9304 where it will be delivered to the user at delivery point 9310. Inother example uses, a person can be inside location 9302 to facilitatethe transaction. Other examples provide a remote pharmacist tofacilitate the transaction from the remote location. For example, thepharmacist can talk to the patient via a telephone or two-way video andthe pharmacist can control the machine 9301 and/or the feed mechanism9304 remotely. In another example, a pharmacist located in location 9302can receive a prescription from a patient via feed mechanism 9304, fillthe prescription, and deliver the product to the patient via the feedmechanism.

[0222] One or more of the ideas discussed above are usable on virtuallyany dispensing machine. For example, the check reader can be utilized ona gas pump, or any vending or dispensing machine that is connected to acheck authorization system.

Conclusion

[0223] The embodiments described above are intended only to illustrateand teach one or more ways of practicing or implementing the presentinvention, not to restrict its breadth or scope. The actual scope of theinvention, which embraces all ways of practicing or implementing theteachings of the invention, is defined only by the following claims andtheir equivalents.

I claim:
 1. A method for dispensing medications or medical supplies,comprising: a medical service provider prescribing a medication for apatient; presenting the prescription to a pharmacy service provider inoral or written form; the pharmacy service provider entering data aboutthe prescription into a data input device that relays the data to amedication dispensing machine; the dispensing machine automaticallylabeling a container holding the medication wherein the container isautomatically labelled with patient-specific information by thedispensing machine; the dispensing machine located remotely from thelocation of the prescribing medical service provider.
 2. A methodaccording to claim 1 further wherein the medication is automaticallylabelled by the dispensing machine at the time that the patient picks upthe medication.
 3. A method according to claim 1 further wherein themedication is automatically labelled by the dispensing machine prior tothe time the patient arrives at the location of the dispensing machineto pick up the medication.
 4. A method according to claim 1 furtherwherein the pharmacy service provider takes a medication container fromthe dispensing machine and gives it to a patient or patient'srepresentative.
 5. A method according to claim 1 further includingproviding the patient with a code and the patient entering the code intothe dispensing machine to obtain the labelled container.
 6. A methodaccording to claim 1 further including networking the control system forthe dispensing machine with a pharmacy management software system.
 7. Amethod according to claim 1 further including presenting theprescription in written form by presenting it on paper to the pharmacyservice provider.
 8. A method according to claim 1 further includingpresenting the prescription in written form by an electronic deliverymechanism.
 9. A method according to claim 1 further wherein the medicalservice provider is located in a medical service delivery facility, andthe dispensing machine is in a location that is not co-located with themedical service delivery facility.
 10. A method according to claim 9further wherein the medical service facility is one of the group of:doctor's office, medical HCF or hospital.
 11. A method according toclaim 1 further including insurance information being provided to apharmacy service provider over an electronic or telephonic link.
 12. Amethod for dispensing prescribed medications, comprising: a prescribingmedical service provider prescribing a medication for a patient;entering data about the prescription into a data input device thatrelays the data to a medication dispensing machine; the dispensingmachine automatically packaging the medication for the patient bylabelling a container of the medication with patient-specificinformation, wherein the dispensing machine is located remotely from thelocation of the prescribing medical service provider.
 13. A methodaccording to claim 12 further wherein the medication is automaticallylabelled by the dispensing machine at the time that the patient comes topick up the medication.
 14. A method according to claim 12 furtherwherein the medication is automatically labelled by the dispensingmachine prior to the time the patient comes to pick up the medication.15. A method according to claim 12 further including providing thepatient with a code and the patient entering the code into thedispensing machine to obtain the labelled medication.
 16. A methodaccording to claim 12 further including networking the control systemfor the dispensing machine with a pharmacy management software system.17. A method according to claim 12 further including presenting theprescription to the pharmacy service provider orally over the telephone.18. A method according to claim 12 further including presenting theprescription in written form by presenting it on paper to the pharmacyservice provider.
 19. A method according to claim 12 further includingpresenting the prescription in written form by an electronic deliverymechanism.
 20. A method according to claim 12 further wherein themedical service provider is located in a medical service deliveryfacility, and the dispensing machine is in a pharmacy that is notco-located with the medical service delivery facility.
 21. A methodaccording to claim 20 further wherein the medical service facility isone of the group of: doctor's office, medical HCF or hospital.
 22. Amethod according to claim 12 further including insurance informationbeing provided to a pharmacy service provider over an electronic ortelephonic link.
 23. A method for dispensing prescribed medications,comprising: a medical service provider prescribing a medication for apatient; entering the prescription into a control system thatcommunicates with a medication dispensing machine; the dispensingmachine automatically labeling a medication container holding theprescription medication with patient-specific information by thedispensing machine; the dispensing machine located remotely from thelocation of the prescribing medical service provider.
 24. A methodaccording to claim 23 further wherein the medication is automaticallylabelled by the dispensing machine at the time that the patient comes tothe drug store to pick up the medication.
 25. A method according toclaim 23 further wherein the medication is automatically labelled by thedispensing machine prior to the time the patient comes to the drug storeto pick up the medication.
 26. A method according to claim 23 furtherincluding providing the patient with a code and the patient entering thecode into the dispensing machine to obtain the labelled medication. 27.A method according to claim 23 further including networking the controlsystem for the dispensing machine with a pharmacy management softwaresystem.
 28. A method according to claim 23 further including presentingthe prescription to the pharmacy service provider orally over thetelephone.
 29. A method according to claim 23 further includingpresenting the prescription in written form by presenting it on paper tothe pharmacy service provider.
 30. A method according to claim 23further including presenting the prescription in written form by anelectronic delivery mechanism.
 31. A method according to claim 23further wherein the medical service provider is located in a medicalservice delivery facility, and the dispensing machine is in a pharmacythat is not co-located with the medical service delivery facility.
 32. Amethod according to claim 23 further wherein the medical servicefacility is one of the group of: doctor's office, medical HCF orhospital.
 33. A method according to claim 23 further including insuranceinformation being provided to a pharmacy service provider over anelectronic or telephonic link.
 34. A method comprising: ordering amedication using an automated order entry system from a first location;obtaining an order code; entering the order code in an automaticdispensing machine in a location geographically remote from the firstlocation; the dispensing machine packaging the medication and presentingit for pick-up.
 35. A method comprising: imaging a written prescriptionand relaying the written prescription inside the same facility as theimaging occurs or to a location remote from the location where the imageis obtained; a pharmacy service provider at the remote location readingthe prescription and entering the order into a control system for adispensing machine; and the dispensing machine labeling the medicationand presenting it for pick-up.
 36. A method according to claim 35further including insurance information being relayed to a pharmacyservice provider in a remote location.
 37. A method comprising:obtaining a prescription in electronic form from a medical serviceprovider; presenting the electronic prescription to pharmacy serviceprovider using an electronic delivery system; a dispensing machinelabeling the medication and presenting it for pick-up.
 38. A methodcomprising: stocking a pharmacy with a variety of medications; locatingan automatic dispensing machine at the pharmacy; staffing the pharmacywith personnel during some but not all hours of a day; filling at leastsome prescriptions for pharmacy customers at least in part by handduring the hours the pharmacy is open; filling at least someprescriptions for pharmacy customers using the dispensing machine duringhours in which there are no pharmacy staff available to dispense byhand.
 39. A method according to claim 38 further wherein the pharmacyservice provider retrieve labelled medications from the dispenser forcustomers during the time they are in, and after hours the customersretrieve prescribed medications from the machine.
 40. A methodcomprising: providing a dispensing machine located at a dispensinglocation; presenting a written prescription for a drug at the dispensinglocation; relaying information from the prescription to a pharmacistlocated remotely from the dispensing location who does not haveimmediate physical access to the dispensing location; the pharmacistremotely operating the dispensing machine to cause it to automaticallylabel a package of the drug with information specific to the patient;the patient obtaining possession of the labeled medication at thedispensing location.
 41. A system for dispensing prescribed medications,comprising: a dispensing machine located at a pharmacy that receivespatient-specific prescription data for a patient and produces a labelledmedication for the patient that is labelled with patient-specificinformation applied by the dispensing machine; the dispensing machinelocated remotely from the location of a prescribing medical serviceprovider who supplies at least a portion of the patient-specificprescription data.
 42. A system according to claim 41 further includinga data input device a pharmacy service provider uses to enter theprescription data.
 43. A system according to claim 41 further whereinthe dispensing machine includes a first computer control mechanismresponsive to a control input to label a labelled medication eitherbefore or after a patient arrives to pick up the medication at thelocation of the dispenser.
 44. A system according to claim 41 furtherincluding a second computer control mechanism that provides the patientwith a code that the patient enters into an input device for thedispensing machine to obtain the labelled container.
 45. A systemaccording to claim 41 further wherein one or more computer controlmechanisms for the dispensing machine are networked with a pharmacymanagement software system.
 46. A method according to claim 41 furtherincluding presenting the prescription in written form by an electronicdelivery mechanism.
 47. A method according to claim 41 further whereinthe medical service provider is located in a medical service deliveryfacility, and the dispensing machine is in a pharmacy that is notco-located with the medical service delivery facility.
 48. A methodaccording to claim 41 further wherein the medical service facility isone of the group of: doctor's office, medical HCF or hospital.
 49. Asystem comprising: a medication order entry device receiving amedication order at a first location; an output device at which apatient obtains a medication pick-up code; a pick-up code enteringdevice receiving the pick-up code for an automatic dispensing machinewherein the dispensing machine is located at the same location or at alocation geographically remote from the first location; and a medicationdispensing mechanism in the dispensing machine outputting a labeledmedication from the dispensing machine wherein the labelling includespatient-specific information.
 50. A system according to claim 49 furtherincluding a terminal connected to the Internet at the first location.51. A system according to claim 50 further wherein the patient entersthe medication order as a refill request at the terminal and furtherwherein the patient obtains the pick-up code from the output devicelocated at the first location.
 52. A system according to claim 50further wherein the terminal is selected from the group of: personalcomputer, personal digital assistant (PDA), or mobile telephone.
 53. Asystem comprising a medication dispensing system including: a) animaging device adapted to image a prescription presented by a patient orthe patient's representative; b) a data input terminal receivinginformation concerning the patient for whom the prescription is written;c) a medication labeling mechanism responsive to a control system andproducing labelled medications labeled with information specific to thepatient; d) a control system receiving instructions from an operatorlocated remotely from the dispensing system.
 54. A pharmacyconfiguration comprising: a store having an enclosed pharmacy floorspace that is secured against unauthorized entry wherein the pharmacyfloor space includes a storage area for medicines; a medicine stockstored in the storage space wherein the medicine stock includes avariety of medications; an automatic medication dispensing machineadapted to dispense labelled medications labeled with patient-specificinformation in response to a customer request, the machine co-locatedwith the pharmacy floor space and accessible to pharmacy customers atleast a portion of the operating hours of the store; and a plurality ofpharmacy service providers working in the enclosed floor space duringsome but not all hours of a day.
 55. A pharmacy configuration accordingto claim 54 further configured so that pharmacy service providersretrieve labelled medications from the dispenser for customers duringthe period of time the pharmacy is staffed, and so that after hours thecustomers retrieve prescribed medications from the machine.
 56. Amedication dispensing system comprising: a dispensing machine having aplurality of medications; a user interface and a medication deliverypoint located remotely from the dispensing machine; and a feed mechanismconnecting the dispensing machine and the medication delivery point;wherein when a user enters authorization information into the userinterface, the dispensing machine automatically labels a medication withuser-specific information, and transports the medication from thedispensing machine to the medication delivery point via the feedmechanism.
 57. The system of claim 56, wherein the feed mechanismincludes a pneumatic tube.
 58. A dispensing system comprising: adispensing machine holding a product; a check reader associated with thedispensing machine and connected to a check authorization service;wherein a user receives the product from the dispensing machine by firstconducting a financial transaction using the check reader.
 59. Thedispensing system of claim 58, wherein the dispensing machine is amedication dispensing machine.
 60. A dispensing machine comprising: ahousing having a product storage system including a plurality of rows ofproducts; a plurality of cantilevered lead screws extending from a rearof the housing to a front of each of the plurality of rows; a pushingmember associated with each lead screw and located at a back of each ofthe rows of products; and a driving member to turn each lead screw toadvance the pushing member towards a front of the housing such that afront product in the row of products is pushed from the row.
 61. Themachine of claim 60, wherein each of the plurality of rows of productsis mounted within a cartridge magazine which is mountable over one ofthe cantilevered lead screws.
 62. A dispensing machine comprising: anenclosure holding a plurality of products; a user interface to order oneor more of the products; a dispensing mechanism to hold each of the oneor more selected products in a first location which is inaccessible tothe user while the order is being filled, the dispensing mechanismcontrolled to release all of the one or more selected products to asecond location accessible to the user only after the order has beenfilled.
 63. The dispensing machine of claim 62, wherein the dispensingmechanism includes a product delivery chute having a product holdingportion and a product delivery portion separated by a movable member.64. A dispensing machine comprising: a housing holding a plurality ofunlabelled products; a labeler located within the housing; a transportmechanism to carry one of the unlabelled products to the labeler; and aproduct rotator to hold the product during labeling; wherein the labelerincludes a label transfer wheel located above the product rotator andmovably connected to the housing such that the wheel moves up and downfollowing the contours of the product being labeled while the product isbeing rotated by the product rotator.